Where a spiritual descendant of Sir William Osler and Abbie Hoffman holds forth on issues of medicine, media and politics. Mostly.

Wednesday, October 2, 2013

Government Shutdown and False Equivalence

There is an awful lot being said and written about the shutdown of the US Federal Government. I won't link to any of the news bits; I assume that if you're reading this, you've been reading at least something about the shutdown. I'm also not going to comment on the politics of the situation, which for me will require incredible self-control. We'll have to check back at the end of this entry and see if I made it successfully.

What I will comment on is the ongoing trope that this is a problem due to radicalization of both political parties. See, for instance, this common "they're all bums" title in an article running up to the shutdown: "Shutdown Crisis Shows Washington Breakdown", which dutifully lays blame at both parties for the troubles throughout the article, as if somehow President Obama is as wild-eyed in his zeal as Ted Cruz.

There has been some scholarly work devoted to this issue of ideological segregation, and the mantra seen in wonky articles on the matter is that both parties have become more pure and extreme. The link above throws in the caveat that the polarization of political parties is asymmetric--that is, it is more extreme on the right than on the left (see political commentary here)--but still sees the trend occurring in both parties.

This seems like utter nonsense to me--or at least is highly misleading--and I think it's based on how one measures "purity". If you have some members of Congress vote with their party 100 percent of the time and zero percent on bills floated by the opposing party, then those party members are 100 percent ideologically pure. If you have different members who vote, say, 75 percent with their caucus and 25 percent against, those people are less pure. The graph shown in the link compares "purity" from 1879 to 2011:

This gives the impression that the political issues between the parties have been more-or-less stable over that time. In reality, a graph of the Republican party from 1879 to 2011 would have shown itself to be a far left party, especially from 1850 through 1880, then a gradual move to the center for the next 80-90 years, then a lurch to the right starting in late 1960s and early 70s, and a much farther jump to the right from Gingrich's speakership on. Yet this isn't what you see on the graphic at all: Republicans occupy the top half of the figure, Dems the bottom.

What is missed, over and over again in these discussions about "party polarization" is that if the parties are becoming more divergent, it is only a phenomenon that can be described relative to each other and not at all about the underlying politics. Meaning: the left wing of the Democratic party may have less in common with virtually any member of the Republican party now than when I was growing up in the 1970s, but the left wing of the Democratic party (at least their representatives in Congress) has moved to the right politically over that time.

The proof can be found in the moronic howling over the very healthcare law that is the source of the shutdown. Despite the Tea Party claims that the ACA is socialism, it bears repeating that the key provision that makes the Affordable Care Act work, the "individual mandate", was essentially invented in the offices of The Heritage Foundation, the right-leaning think tank. (It also is worth noting that "Obamacare" is structurally the same as "Romneycare", and that the former Presidential candidate who campaigned on the repeal of Obamacare seemed pretty pleased with himself when his health care bill passed as Governor of Massachusetts. The fact that this needs to be noted is indicative of the ignorance of so many people who play key roles in forming policies for the Federal government.) Thus, by any sane definition, the ACA is a rightward bill that should have passed with tremendous Republican support, and would have a generation ago if Clinton had lost the Presidency to Bob Dole in 1996. The Republican party would then have claimed this as a legislative victory, and who knows what would have changed in domestic politics as a consequence.

A Tea Party-equivalent left wing approach to health care reform would have been truly nationalizing health care like Britain, where doctors are government employees and hospitals government buildings. Currently we have something similar in the US in the form of the Veteran's Administration health care system, which is truly a federal government operation from beginning to end. It's also reasonably popular. Despite this, there were only a few Dems open to this idea, and it was never realistically discussed. A moderate left-wing solution to the healthcare problem was to push for "Single Payer", in which the government takes over the functions that the private insurance industry handles. This could be thought of as "Medicare For All", and to this day I don't understand why the Dems didn't embrace this sales pitch given Medicare's popularity. But Single Payer, even though there was a Tea Party-sized chunk of the Dem caucus that supported it, was deemed out of the question by party leaders, and never took center stage in policy discussions.The centrist position was one in favor of the "Public Option", which would not force everyone into the Medicare pool but allow them to opt-in. It had a huge amount of support among rank and file Democrats; indeed, this was approved in the initial bill passed by the House, but was dead on arrival in the Senate for procedural reasons (it's unclear if it would have passed the Senate, but probably would have if it came to a vote). Even that approach, however, which was somewhere between mainstream and concessionary Democratic philosophy, couldn't survive the legislative process. So we got instead a law that would have warmed the cockles of Newt Gingrich's heart in the mid 1990s, yet you still hear reporters and talking heads let go unchallenged statements about the "problems of the radicals on both sides".

The two parties aren't getting more radical. Both parties have moved to the right. Repeat: both parties have moved to the right over the past two generations. Just because one of them has done so at an alarmingly accelerated rate doesn't mean the other has moved in the other direction. It's an optical illusion, and yet our media largely contributes to the underlying problems driving this crisis by their constant and tedious exercise in false equivalence. I would argue, to borrow a recent use of the phrase by Senator Rand Paul, that it's time to point out that the emperor has no clothes, although Paul might not approve of my meaning.

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About Me

I'm a physician and an educator with a clinical focus in infectious disease. I teach the spectrum from 3rd year medical students through senior ID fellows, and try to keep everyone loose when doing so. Whether I succeed or not, you'll have to ask them.
I am interested in issues where medicine intersects with politics, as well as how medical research is portrayed by media. In some ways my views are very much at the fringe of the rest of the physician community, although in several other critical ways I’m your typical stethoscope-wielding, white-coat-wearing, reflex-hammer-tapping doc and consider myself steeped in the traditions of the brotherhood and sisterhood.